Intrauterine exposure to clomiphene and neonatal persistent hyperplastic primary vitreous

Abstract

A 4‐year‐and‐10‐month‐old girl was diagnosed shortly after birth with persistent hyperplastic primary vitreous (PHPV). Her mother took clomiphene 100 mg daily for approximately 4 weeks and discontinued the drug once she had a positive pregnancy test. The exact time of gestation was not clear. Clomiphene is an estrogen antagonist effective in the treatment of anovulation. Various ocular side effects have been described in women taking the drug, including decreased vision, mydriasis, flashing lights, central scotoma, photophobia, diplopia, allergic reactions, retinal vasospasms, detachment posterior vitreous, and possibly posterior subcapsular cataracts. These occur in 1.5–10% of patients taking clomiphene. The potential effects of clomiphene on the fetus have been investigated in five animal studies. Cataracts were observed in fetal mice and rats, but not in monkeys. In humans, a case of congenital retinal aplasia was described. The possibility of clomiphene‐induced congenital PHPV should be considered, especially in pregnant women who are taking a high and prolonged dose. Teratology 60:143–145, 1999. © 1999 Wiley‐Liss, Inc.

RETRACTED: Clomiphene citrate or anastrozole for ovulation induction in women with polycystic ovary syndrome? A prospective controlled trial

“…Mitwally et al (21) reported favorable pregnancy outcomes and a low multiple-gestation rate for the use of aromatase inhibitors for ovarian stimulation. Clomiphene citrate has been reported to elicit various ocular side effects in 1.5%-10% of patients taking it (22). Toxicology studies have shown that anastrozole is well tolerated at 1 and 6 months.…”

RETRACTED: Clomiphene citrate or letrozole for ovulation induction in women with polycystic ovarian syndrome: a prospective randomized trial

“…Information on the teratogenic capacity of letrozole in humans is lacking, but animal studies have shown that low doses of letrozole are effective in inducing noxious effects on the developing conceptus (22). In the rat, teratogenic effects, including fetal domed head and cervical/centrum vertebral fusion, resulted from exposure to 0.03 mg/kg.…”

“…Mitwally et al (23) reported favorable pregnancy outcomes and low multiple gestation rates with aromatase inhibitors for ovarian stimulation. Clomiphene citrate has been reported to elicit various ocular side effects in 1.5% to 10.0% of patients taking CC (22).…”

Gender Specific Issues in Hereditary Ocular Disorders

“…A case report of Persistent Hyperplastic Primary Vitreous (PHPV) in an exposed offspring from clomiphene is an example of such an anecdotal report without any population-based data regarding the frequency of such effects. 79 The breast cancer medication tamoxifen is a selective-estrogen receptor modulator 31 that is structurally similar to clomiphine and has been used as a fertility agent and breast cancer treatment medication. 80 Ocular side effects of tamoxifen are varied and include increased risk of posterior subcapsular cataracts, optic neuropathy, and foveal cystoid spaces.…”